Effects of two intervention strategies on the behavior of nurses and nurse students related to advance directives

Advance directives are one mechanism for preserving the rights of individuals to exercise some control over their health care when serious illness may prevent them from direct participation. Nurses, as the health care providers with the closest and most sustained contact with critically ill and dying patients, are positioned to assist patients to plan for future health care needs. Although a majority of nurses favor the concept of advance directives for their patients and for themselves, they have not played a significant role in facilitating advance health care planning with their patients nor implemented advance health care planning for themselves.^ Research has also shown that differing forms of education and counseling increase the completion rates for advance directives in selected populations, mostly the elderly and seriously ill. Not yet developed are effective educational strategies to assist nurses and nurse students to make optimal contributions in assisting their clients' plans for future health care decision-making. This study sought to determine whether specific learning strategies (a) increased the involvement of nurses and nurse students in facilitating advance care planning with patients and (b) increased the percentage of the nurses' and nurse students' own personal advance care planning activities.^ The study compared two learning interventions and two populations, nurses and nurse students. The participants were randomly assigned to one of the two learning interventions, L1 or L2. Participants in L1 received a lecture, discussion and exploration of the forces impacting on advance directive behavior. Participants in L2 received the same intervention components with the additional component of group practice completing advance directives.^ Analysis of the data by chi-square and logistic regression did not support the hypotheses that the practice component would make a difference in the participants' facilitation of advance care planning with patients or in their own personal advance care planning activities. There were significant differences in post-intervention behavior between the nurse and nurse student groups. The nurses in the study did significantly more facilitation of advance care planning with patients and completed significantly more advance care documents than the nurse students post-intervention. However, the nurse students held more post-intervention family discussions than did the nurses. ^

The relationship between participation in unethical behaviors during the nursing student experience and participation in unethical behaviors as a registered nurse

The effect of unethical behaviors in health care settings is an important issue in the safe care of clients and has been a concern of the nursing profession for some time. The purpose of this study was to examine the relationship between use of unethical behaviors in the nursing student experience and the use of unethical behaviors in the workplace as a registered nurse. In addition, the relationship between the severity of unethical behaviors utilized in the classroom, clinical setting and those in the workplace was examined. To insure greater honesty in self-report, only a limited number of demographic variables were requested from participants.^ During the summer of 1997, a 56 item questionnaire was distributed to registered nurses enrolled in either undergraduate or graduate courses in a public or private institution. The participants were asked to self-report their own use of unethical behaviors as well as their peers use of unethical behaviors. In order to assign a severity score for each item, nursing school faculty were asked to rate severity of unethical behaviors which could be used during the nursing student experience and nursing administrators were asked to rate unethical behaviors which could be used in the workplace.^ A significant positive relationship was found between individuals' use of unethical behaviors during nursing school and those used in the workplace $r=.630.$ A significant positive relationship was found between the severity of unethical behaviors used in the nursing student experience and the severity of unethical behaviors used in the workplace $r=.637.$ No relationship was found between years of practice, type of initial nursing education and whether or not the participant was raised inside or outside the United States and the use of unethical behaviors. ^

Laypersons' awareness of the role and function of the nurse practitioner

The purpose of this descriptive study was to document the level of awareness that laypersons have regarding the role and function of the nurse practitioner (NP). An instrument developed for a similar study, conducted in 1994, comparing patients' and physicians' level of knowledge of the role and function of the NP, had a low reliability. Revision of the instrument was required before further use could be justified.^ A pilot study of 25 laypersons was conducted to ensure that the revised tool was reliable prior to conducting a study. Reliability for the pilot sample was 0.84.^ The study results indicated that the majority of the sample (83%), (n = 100) knew that a NP was a registered nurse who was qualified to diagnose and treat minor illnesses. The level of layperson awareness was limited regarding prescriptive privileges, well-woman exams, and the NPs' ability to perform physical exams, and interpret lab results and x-rays. ^

Sequence analysis of complementary DNAs encoding C3 in the nurse shark ({\it Ginglymostoma cirratum\/})

Mammalian C3 is a pivotal complement protein, encoded for by a single gene. In some vertebrate species multiple C3 isoforms are products of different C3 genes. The goal of this study was to determine whether multiple genes encode for shark C3. A protocol was developed for the isolation of mRNA from shark blood for the isolation of C3 cDNA clones. RT-PCR amplification of mRNA, using sense (GCGEQNM) and antisense (TWLTAYV) primers encoding conserved regions of human C3, yielded 21 clones. The C3-like clones isolated shared 97% similarity with each other and 40% similarity to human C3. RACE-PCR amplification of shark liver RNA, using gene specific primers, yielded products ranging from 1800bp to 3000bp. Deduced amino acid sequence, corresponding to 408bp of the 1800bp fragment, was obtained which showed 51% similarity to human C3. These results suggest that nurse shark C3 might be encoded for by more than one gene. ^

The role of attitudes, subjective norms, attributions, and individualism-collectivism in managers' responses to bribery in organizations: The case of Ecuador

The goal of this study was twofold: (1) to introduce a model explaining how attitudes, subjective norms, internal and external attributions about bribery affect the way managers' deal with bribery in organizations, and (2) to clarify the role of the individualism-collectivism cultural dimension in managers' attributions of employees' behavior related to bribery. Twenty-six internal and external attributions related to bribery were identified through a series of structural interviews with 65 subject matter experts, and then evaluated by three hundred fifty-four (n = 354) Ecuadorian managers. Hierarchical regression analyses indicated that attitudes and external attributions significantly predicted managers' intentions to discipline employees' who accepted a bribe, and that those with a collectivist orientation were more likely to make external attributions of bribery. Implications for the eradication of bribery in organizations are discussed. ^

The career development of Black female chief nurse executives

This qualitative study was designed to explore the career development of Black female chief nurse executives. Although a small proportion of Black female nurses have achieved positions at the nurse executive level, there remains a paucity of Black female nurse executives in this crucial position which raised the question of what factors contributed to this lack of advancement, but, more important, what factors have contributed to the success of the few who have achieved such level of success in healthcare organizations. The purpose of the study was to explore the career paths of Black female chief nurse executives with a view of understanding the factors which both facilitate and hinder the career development of these leaders in healthcare organizations. The guiding research question was, How do Black female nurse executives in this sample describe their career development? The participants in this study were Black female chief nurse executives located throughout the United States who, for the most part, were raised in segregation with a strong family foundation. To collect data, semistructured telephone interviews were conducted with 10 Black female chief nurse executives throughout the United States. The transcripts from the interviews were transcribed, coded, and analyzed. Using Super’s (1990, 1996), and Gottfredson’s (1981, 1996, 2002, 2005) career development theories and critical race theory (Crenshaw, 1995; Delgado, 2000) as the theoretical framework, the researcher found that the participants’ career development was influenced by (a) strong support system, (b) guidance, (c) influence of diversity, and (d) servant leadership. The findings help us understand the factors that have contributed to their successes as Black chief nurse executives. With the increasingly diverse population and concurrent increasing diversity in nursing and concerns about healthcare disparities, it is imperative that organizations attract, hire, develop, retain, and advance qualified Black nurses. Future studies addressing not only the career development of Black nurses but nurses in general might be informed by the present study’s findings. Recommendations are offered for nursing practice, education, and organizational policy.

Managing small-medium cities in a time of globalization: Experiences and evidence from Florida's public managers

This study examines how public management practitioners in small and medium-sized Florida cities perceive globalization and its impact on public management practice. Using qualitative analysis, descriptive statistics and factor analysis methods, data obtained from a survey and semi-structured interviews were studied to comprehend how public managers view the management and control of their municipalities in a time of globalization. The study shows that the public managers’ perceptions of globalization and its impact on public management in Florida’s small-medium cities are nuanced. Whereas some public managers feel that globalization has significant impacts on municipalities’ viability, others opine that globalization has no local impact. The study further finds that globalization processes are perceived as altering the public management functions of decision-making, economic development and service delivery in some small-medium cities in Florida as a result of transnational shifts, rapidly changing technologies, and municipalities’ heightened involvement in the global economy. The study concludes that the globalization discourse does not resonate among some public managers in Florida’s small-medium cities in ways implied in extant literature.

Low-income first time mothers: Effects on advanced practice nurse (APN) follow up telephone calls on maternal and infant health and health care charges

The United States has over 4 million births annually. Currently healthy women with non-complicated deliveries receive little to no routine postpartum support when discharged from the hospital. This is especially problematic if mothers are first time mothers, poor, have language barriers and little to no social support after giving birth. The purpose of this randomized clinical trial was to compare maternal and infant health outcomes, and health care charges between 2 groups of mothers and newborns. A control ( n = 69) group received routine posthospital discharge care. An intervention group (n = 70) received routine posthospital discharge care plus follow up telephone calls by advanced practice nurses (APNs) on days 3,7,14,21,28 and week 8. Both groups were followed for the first 8 weeks posthospital discharge following delivery to examine maternal health outcomes (perceived maternal stress, social support and perceived maternal physical health), infant health outcomes (routine medical follow up visits immunizations, weight gain), morbidity (urgent care visits, emergency room visits, rehospitalizations), health care charges (urgent care visits, emergency room visits, rehospitalizations) in both groups and charges for APN follow up in the intervention group only. Data were analyzed using descriptive statistics and two-sample t-tests. Study findings indicated that intervention group had significantly lower perceived maternal stress, significantly higher rating of perceived maternal health and higher levels of social support and by the end of the 2nd month posthospital discharge compared to control group mothers. Infants in the intervention group had: increased number of immunizations; fewer emergency room visits; and 1 infant rehospitalization compared to 3 infant rehospitalizations in the control group. The intervention groups' health care charges were significantly lower compared to the control group $14,333/$497 vs. $70,834/$1,068. These study results indicate that an intervention of APN follow up telephone calls in this sample of first time low-income culturally diverse mothers was an effective, safe, low cost, easy to apply intervention which improved mothers' and infants' health outcomes and reduced healthcare charges.

Antibacterial proteins and peptides in nurse shark ( Ginglymostoma cirratum) peripheral blood leukocytes

In many vertebrate and invertebrate species mediators of innate immunity include antimicrobial peptides (AMPs) such as peptide fragments of histones and other proteins with previously ascribed different functions. Shark AMPs have not been described and this research examines the antibacterial activity of nurse shark (Ginglymostoma cirratum) peripheral blood leukocyte lysates. Screening of lysates prepared by homogenizing unstimulated peripheral blood leukocytes identified muramidase (lysozyme-like) and non-muramidase antibacterial activity. Lysates were tested for lysozyme using the lysoplate assays, and antibacterial (AB) activity was assayed for by a microdilution growth assay that was developed using Planococcus citreus as the target bacterium. Fractionation of crude lysates by ion exchange and affinity chromatography was followed by a combination of SDS-PAGE with LC/MS-MS and/or N-terminal sequence analysis of low molecular weight protein bands (<20 kDa). This yielded several peptides with amino acid sequence similarity to lysozyme, ubiquitin, hemoglobin, human histones H2A, H2B and H4 and to antibacterial histone fragments of the catfish and the Asian toad. Not all peptide sequences corresponded to peptides potentially antibacterial. The correlation of a specific protein band in active lysate fractions was accomplished by employing the acid-urea gel overlay assays in which AB activity was seen as zones of growth inhibition on a lawn of P. citreus at a position corresponding to that of the putative AB protein band. This study is the first to describe putative AMPs in the shark and their potential role in innate immunity.^

Recruitment, Selection and Retention of Managers In the Hotel and Restaurant Industry

The recruitment, selection, and retention of competent, reliable, and motivated managers has been the cornerstone of any successful organization. This is generally a complex assignment due to the subjectivity involved in determining what traits are needed to make a good manager. In order to determine the status of the hospitality industry with regard to managerial concerns, leaders in the hotel and restaurant industry were surveyed on these issues.

Financial Ratios: Perceptions of Lodging Industry General Managers, and Financial Executtves

Financial ratios are the most meaningful information in financial statements to executives and managers. The author analyzes the results of two surveys designed to rank the degree of importance and usefulness of these ratios to several user groups.

Strategic Human Resources Management Performance Metrics for Unit-Level Managers: An Exploratory Study of U.S Casual Restaurants

Many restaurant organizations have committed a substantial amount of effort to studying the relationship between a firm’s performance and its effort to develop an effective human resources management reward-and-retention system. These studies have produced various metrics for determining the efficacy of restaurant management and human resources management systems. This paper explores the best metrics to use when calculating the overall unit performance of casual restaurant managers. These metrics were identified through an exploratory qualitative case study method that included interviews with executives and a Delphi study. Experts proposed several diverse metrics for measuring management value and performance. These factors seem to represent all stakeholders’interest.

Challenge to Managers: Changing Hotel Work from a Secondary Choice to career Development

In his discussion - Challenge To Managers: Changing Hotel Work from a Secondary Choice to Career Development - by Leonidas Chitiris, Lecturer in Management, Piraeus Graduate School of Industrial Studies, Athens, Greece, Chitiris marginally alludes at the outset: “Surveys and interviews with hotel employees in Greece with regard to why individuals work for hotels and to what extent their rationale to join the hotel industry affects hotel productivity revealed that the choice to work in hotels is a secondary preference and reflects the opportunity structure in the economy at any given time and the greater the number of those who work in hotels when there are no other employment opportunities, the less likely the chances for overall improved performance. Given the increase in the proportion of unskilled, unmotivated workers, the level of hotel productivity consequently decreases! The author interprets the findings in terms of the economic and employment conditions in the Greek hotel industry. To enhance the rationale of his thesis statement, Chitiris offers with citation: “Research on initial entry into the labor force has shown that new employees reflect idealized expectations and are frequently not very satisfied with their jobs and roles in the work settings.” Chitiris advances the thought even further by saying: “Research on job satisfaction, motivation, and production purports that management can initiate policies that develop job satisfaction and may improve productivity.” The author outlines components within the general category of the hotel industry to label and quantify exactly why there may be a lag between employee expectations and the delivery of a superior level of service. Please keep in mind that the information for this essay is underpinned by the hotel industry in Greece, exclusively. Demographic information is provided. One example of the many factors parsed in this hotel service discussion is the employee/guest relationship. “The quality of service in hotels is affected to a great extent by the number of guests a hotel employee has to serve,” Chitiris offers. Additionally, Chitiris’ characterization of the typical hotel employee in Greece is not flattering, but it is an informed and representative view of that lodging labor pool. The description in and of itself begs to explain at least some of why the hotel industry in Greece suffers a consequently diminished capacity of superior service. Ill equipped, under-educated, over-worked, and under-paid are how Chitiris describes most employees in the Hellenist hospitality field. Survey based studies, and formulaic indices are used to measure variables related to productivity; the results may be inconclusive industry wide, but are interesting nonetheless. Also, an appealing table gauges the reasons why hotel workers actually employ themselves in the lodging industry. Chirtiris finds that salary expectations do not rate all that high on the motivational chart and are only marginal when related to productivity. In closing, Chirtiris presents a 5-phase development plan hotels should look to in improving performance and productivity at their respective properties.

Empowering Catering Sales Managers with Pricing Authority

In the hotel business, catering sales managers often encounter potential clients who expect to negotiate for items such as room rental fees, audiovisual charges, and bartending fees. This article addresses both the advantages and disadvantages of empowering sales managers with the authority to reduce or waive these charges. Thus, hoteliers are advised to extend a structured yield management mindset into the hotel’s function-space area.